Assessment of left atrial appendage function by strain-Doppler-transesophageal echocardiography in atrial fibrillation pre-post- direct current cardioversion or pulmonary vein isolation

Background. The utility of transesophageal echo (TEE) in assessing left atrial (LA) or left atrial appendage (LAA) function is well known in patients with atrial fibrillation undergoing direct current cardioversion (DCC) but its utility in patients undergoing pulmonary vein isolation (PVI) is uncertain. Methods. 64 patients (pts) with AF before DCC (38 pts) or PVI (26 pts) were studied. Patients were grouped into those who remained in sinus rhythm (group 1, n =35) and those who had AF recurrence between 1 and 6 months after cardioversion (group 2, n= 19) or ablation (group 3, n= 10). Strain rate imaging (SRI) of the basal LA wall was performed. Systolic (SR-S) and early diastolic (SR-E) deformation were determined. Left atrial appendage emptying (LAA-EV) and filling (LAA-FV) velocities and peak pulmonary venous systolic wave velocity (PV-SV) were also obtained. Results. SR-E was significantly lower in group 2 than group 1 (p <0.005). Group 3 pts had significantly lower LAA-EV (18 ± 11 vs 30 ± 13 cm/s) and lower PV-SV (38 ± 14 vs 48 ± 21 cm/s) compared with group 1. Multivariate regression analysis showed that lower SR-E, LAA-EV and PV-SV were independent predictors of failure of cardioversion and/or ablation. SR-E combined with LAA-EV improved the sensitivity and specificity for predicting successful DCC or PVI. Conclusions. Pre- and post-procedural TEE is important in assessing LA and LAA function in patients with AF undergoing DCC or PVI and predicting the success of the procedure and likelihood of maintenance of sinus rhythm.